Hospital Newspaper New Jersey December 2013

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If you are a Hospital employee looking for a mortgage or refinancing contact Sun Home Loans about their Hospital Employee Loan Program and you could WIN AN IPAD! See page 12

Hospital of tHe Year!

Raritan Bay Medical Center See page 14

Don’t Miss!

67th Annual PostGraduate Assembly in Anesthesiology December 13-17 Marriott Marquis New York See page 27

Creating a Strategic Partnership for Mutual Success A Case Study Presented by PHX p4

Fund-Ex Provides Customized Financing Solutions to Healthcare Professionals p10

DECEMBER 2013

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December, 2013

Hospital Newspaper - NJ

WHAT WHA AT MAKES MAKES A LEADER LEADER IN HEAL HEALTHCARE THCARE C TH COST OS ST MANAGEMENT? MANAGE A EMENT?

S T C U D O PR CE N A M R PERFO HIP S R E N T R PA

At PHX, we of offer fer a comprehensive solution th that’s hat’s tailored to fit your advantage business – take adva antage of our suite of innovative ovative Products and Performance long-term Partnership. outstanding Per formance m e while building a lo ong-term Par tnership. >> 888.311.3505 PHX-online.com 888.311.3505 | P HX-online.com

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Hospital Newspaper - NJ December, 2013

The best-dressed wounds in New Jersey.

That’s the beauty of Trinitas.

T

he Center for Wound Healing & Hyperbaric Medicine at Trinitas Regional Medical Center is New Jersey’s leading comprehensive wound care center. We utilize advanced wound care technologies such as Hyperbaric Oxygen (HBO) Therapy and Vacuum-Assisted Closure (VAC®) negative pressure wound therapy. And we were the first in the state to use Apligraf ® - a living, bi-layered skin substitute.

We enjoy healing rates that are consistently above 90%. That’s why so many area hospitals send their most difficult wounds to us. And why Diversified Clinical Services named us a Center of Excellence.

This is wound care that goes way beyond bandages. And it’s available right here, right now. Beautiful.

CENTER FOR WOUND HEALING & HYPERBARIC MEDICINE 240 Williamson St., Suite 104, Elizabeth, NJ 07202 908-994-5480 • www.WoundHealingCenter.org TRINITAS CENTERS OF EXCELLENCE

Behavioral Health • Cancer Care • Cardiology • Diabetes Management Maternal & Child Health • Renal Services • School of Nursing • Senior Services Sleep Disorders • Women’s Services • Wound Healing & Hyperbaric Medicine

Trinitas Regional Medical Center is a Catholic teaching institution sponsored by the Sisters of Charity of Saint Elizabeth in partnership with Elizabethtown Healthcare Foundation.

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December, 2013

Hospital Newspaper - NJ

“Creating a Strategic Partnership for Mutual Success” A Case Study Presented by PHX Summary In today’s business environment, more companies are taking steps to protect the core competencies of their businesses while outsourcing other key functions to allow for increased efficiencies. Since many businesses are now characterized with partner relationships and the line of what divides the business from the vendor can be somewhat obscure, it is essential to develop strategic alliances that are transparent to the end user.

This case study describes how a 30,000 life Payor re-evaluated its current vendor relationship and book of services to develop a long term strategic vendor partnership which would strengthen their business and allow them to focus on one of their core competencies, customer-centric service. The Payor believed that dedication to a strong vendor relationship would lead to long term operational efficiency, higher levels of “end” customer care and an overall competitive edge in the marketplace.

Key Challenges Our highlighted Payor had some key fundamental issues which were hindering their claims cost solution from achieving peak performance. Claims Editing and Out-of-Network services were being performed by a cost management vendor and Bill Review and Audit was serviced by another 3rd party external source.

This led to multiple outsourcing venues analyzing identical data and thus increased the complexity of their cost management solution. In addition, the Payor was not receiving the required level of service, had conflicting goals, and was not able to create a balanced, equitable risk scorecard –all of which led to an inadequate vendor relationship.

During the subsequent 12 months, using all three of PHX services, claims followed the effectual path to ensure maximized savings:

➢

Upon receipt, claims were first routed through a “proprietary” claims editing system which determined accuracy of coding. After the initial automated edits were completed, claims were then transferred to a team of certified coders. These coding professionals reviewed the patient claim history for each claim and determined appropriateness of billing. This process discovered over $1.9mm in savings.

➢

From claims editing, all claims then traveled to our Bill Review and Audit department where a team of nurses performed line by line audits to determine the accuracy of each claim’s charges. This stage captured an additional savings of over $866,000.

➢

Finally, the claims were routed to the PHX Out-of-Network where expert negotiators conducted claim by claim negotiations to achieve and secure an additional $1.8mm savings.

In parallel to this process, PHX assigned a team of cross functional specialists to provide “hands-on” guidance to the Payor’s needs during the planning and implementation process.

The consulting services ranged from providing operational guidelines to coordinating a marketing analysis with recommendations for the Payor’s target audiences of brokers, employers and members.

To resolve these issues, our Payor decided to evaluate other options in the marketplace.

The goal was to secure a new vendor relationship characterized as a long term partnership with common objectives of service combined with maximized cost savings.

As a part of their vendor selection process, they engaged PHX to provide an analysis of savings from their claims management solution. The objective of the analysis was to explore the ability of PHX to improve the Payor’s operational efficiency, provide maximum savings by generating the “real” costs associated with their claims, and ensure the highest level of customer service. The solution involved the utilization of PHX’s Integrity Services which includes Claims Editing, Bill Review-Audit, and Out-of-Network negotiation services to deliver maximized savings. Also, PHX’s Account Management and Operations teams were used as resources enabling PHX to leverage its technologies and strategic partnership protocols to ensure efficient workflow, expected outcomes and client satisfaction.

Solution The Payor decided to convert its operational processes

in multiple steps. This provided a safeguard for the savings being realized at each level with minimal disruption of operational procedures. The initial step for the Payor was to manually forward claims to PHX for Bill Review and Audit. After successful results were realized for Bill Review, the Payor transitioned to an automated process and began transmitting claims for all three services. These post adjudication-prepayment claims totaled over $19.6mm.

Results By eliminating the need to use multiple outside vendors and utilizing all the PHX Integrity Services, our spotlighted Payor was able to reduce the complexities of routing claims to external venues. This led to total savings for the TPA in the amount of $4.6 million. These savings helped to achieve their financial objectives and affords the opportunity for the client to redistribute those savings to other areas of their business and to increase their competitive advantage.

Moreover, during this time period, an alliance formed with PHX ensured that common objectives were being fulfilled for both parties. The crucial requirement was that consistent customer service was delivered on a daily basis. This was achieved through the established practices of the PHX Client Services Team. These policies require the response time to all client inquiries to be within 24-48 hours of receipt as well as being proactive in recommending best practices when warranted.

For more information about PHX Services, visit us at www.phx-online.com.

This successful strategic partnership between the Payor and PHX ultimately enriched the solutions and value provided to end customers, expanded overall knowledge about the marketplace, and allowed both parties to fuse together the core capabilities they each possess for the purpose of complementing each other’s business goals.

Hospital Newspaper - NJ December, 2013

A uunique nique bus iness... business... requires i a unique nnetwork. etwork.

PHX – network solutions management solution ns to help lower your

Š2013 Premier Healthcare Exchange, Inc Inc. c. All Rights Reser Reserved. ved.

healthcare costs

>> 888.311.3505 888.311.3505 | PHX-online.com

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December, 2013

Hospital Newspaper - NJ

OUR VIEW

ADVERTISER INDEX Company

Page

Home for the Holidays!

AkRimAx / Nitromist

28

Bankers Healthcare Group, inc.

11

Bergen Regional medical Center

13

Robert Painter, PLLC

EmA

7

GNYHA Services

9

Have you ever noticed that any time you or family member gets sick, it seems to happen on an evening, weekend or holiday? That certainly seems how it goes in our family.

Did you know, though, that during these times the risk of medical and nursing errors in the hospital is much higher than normal?

If possible, avoid hospitals on weekends, evenings and holidays.

No matter the occupation or workplace, most people enjoy taking time off from work around the holidays and during the summer. Most people also prefer to work day shifts, rather than evenings or weekends. Generally, personnel with the most seniority get to choose the plum shifts and get preference for taking time off.

Hospitals are no different. The most senior, experienced doctors and nurses are usually nowhere to be found during holidays. They are also pretty scarce on evenings, weekends and quite often during summertime. Instead, during these time periods, patients will likely be treated by inexperienced doctors and nurses, with little direct supervision from more seasoned health care professionals.

My advice is to avoid a hospitalization, if at all possible, during these periods. A safer alternative is to select another date when the more experienced health care providers will likely be at work. Some people try to schedule elective procedures when they are off work, like during holidays. Based on the data, though, this is not such a good idea.

Hospital Newspaper wishes a happy and HEALTHY Holiday season to all of readers.

Thanks to our supporters Hospital Newspaper has grown to become the leading medical publication in each state we serve!

Less Stress instructional Services

18

matheny School and Hospital

19

NorthWest Seminars

25

PGA67

27

Premier Healthcare Exchange, inc. (PHx) 2, 5 Plymouth Rock management Co of NJ

21

Raritan Bay medical Center

15

Resource Directory

24, 26

RWJ Rahway

23

Sun Home Loans

12

St. Peter’s University

17

Trinitas Regional medical Center

H

3

HOSPITAL NEWSPAPER

845-534-7500 • (fax) 845-534-0055 Info@HospitalNewspaper.com

Credit: Robert Painter is an attorney and member of Painter Law Firm PLLC.

Please e-mail your thoughts to news@hospitalnewspaper.com or write to Hospital Newspaper, 1 Ardmore Street, New Windsor, NY 12553.

Jim Stankiewicz can be reached at 845-534-7500 ext. 219 and via email at jim@hospitalnewspaper.com.

PUBLISHER

Joseph P. Belsito (Joe@hospitalnewspaper.com)

HOSPITAL

H

••• GENERAL MANAGER

James Stankiewicz (Jim@hospitalnewspaper.com)

••• MANAGING EDITOR

Cathryn Burak

NEWSPAPER

Go to www.hospitalnewspaper.com click on Online Newspaper Subscription Form

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Geraldine A. Collier

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Maureen Rafferty Linell (MRLinell@charter.net)

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Anthony Mairo (Anthony@hospitalnewspaper.com)

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CIRCULATION

Michelle Belsito (845-534-7500 x220)

••• BUSINESS DEVELOPMENT, PUBLISHER'S REPRESENTATIVE

Jeff Horton

Field office; Mahopac, NY cell- 845-729-2525 jeff.hospitalnewspaper@gmail.com

CORPORATE INFORMATION Hospital Newspaper - New Jersey edition - Vol. 11 No. 12is published monthly, 12 times a year for $36 per year by Belsito No. Communications, 1 Ardmore Street, New 1 - is publishedInc., monthly, 12 times a year for Windsor, NY 12553. Postage Paid at New Windsor, NY $ and additional mailing offices. Postmaster: Send address changes to Hospital Newspaper, 1 Ardmore Street, New Windsor, NY 12553. No financial responsibility is assumed by this newspaper to publish a display, classified, or legal ad or for typographical errors except of reprinting that part of the ad which was omitted or in error. Omissions or errors must be brought to the attention of the newspaper during the same month of publication.

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Hospital Newspaper - NJ December, 2013

Emergency Medical Associates Named to Modern Healthcare’s Best Places to Work in Healthcare List for the Third Year Emergency Medical Associates is among 100 companies nationwide who have been named to the 2013 Best Places to Work in Healthcare list compiled by Modern Healthcare magazine. Emergency Medical Associates is pleased to be the highest ranked emergency medicine physician group on Modern Healthcare’s list.

The recognition program, now in its sixth year, honors workplaces that enable employees to perform at the optimum level to provide patients and customers with the best possible care, products and services. This is the third year that the company has been named to the list.

“Since 1977, our physicians, mid-level providers and support staff have enjoyed a work environment where quality and excellence in practice is the norm. We reward clinical acumen with competitive compensation and benefits, and opportunities for advancement,” explains Raymond Iannaccone, MD, FACEP, president and chief executive officer of Emergency Medical Associates. “We’re honored to again be recognized

by Modern Healthcare.”

Nearly 350 healthcare companies participated in this year’s program.

The program surveyed employees and analyzed their responses in eight core areas: • Leadership and planning • Culture and communications • Role satisfaction • Working environment • Relationship with supervisor • Training and development • Pay and benefits • Overall satisfaction

About Emergency Medical Associates Emergency Medical Associates (EMA), headquartered in Parsippany, N.J., is a physician-led, physician-owned medical practice that specializes in emergency, hospitalist and urgent care medicine. Dedicated to providing exceptional solutions for the measurable success of our hospital partners, EMA is recognized for clinical excellence, quality service and sustained improved patient satisfaction.

For more information, visit www.ema.net, www.facebook.com/EMANews or www.twitter.com/EMANews.

The Sign of Excellence ence in Emergency Medicine edicine® ree Decades for More Than Three

Stuhlmiller Co-authors Article for Air Medical Journal David F.E. Stuhlmiller, MD, FACEP, CMTE, co-authored an article for Air Medical Journal. The article, which appeared in the September 2013 issue of the publication, was titled, “Critical Care Transportation

by Paramedics: A Cross-Sectional Survey.”

Dr. Stuhlmiller is a partner of Emergency Medical Associates and chairman of the department of emergency medicine at Newton Medical Center, Newton, N.J.

Modern Healthcare revealed the ranked order of the 100 Best Places to Work in Healthcare Oct. 24 at a banquet in Atlanta.

Patel Participates in Panel Discussion at NJ-ACEP Hetal Patel, MD, participated in a panel discussion at the New Jersey chapter of the American College of Emergency Physicians Scientific Assembly held May 7 at the Princeton Marriott at Forrestal.

The panel discussion topic was simulation medicine followed by simulated patient care scenarios.

Residents competed in teams and involved simulation cases of traumatic rhabdomyelolysis, pediatric botulism, and intussusception.

Dr. Patel is a partner of Emergency Medical Associates and is an emergency physician at Morristown (N.J.) Medical Center.

Page 7

Nevins Gives Lecture at Morristown Medical Center Sol Nevins, MD, FACEP, gave a lecture to emergency medicine residents at Morristown Medical Center Aug. 6. The presentation was entitled, “Surviving a Career in Emergency Medicine.”

Dr. Nevins, an attending emergency physician, was a past recipient of the “New Jersey EMS Medical Director of the Year” award from the NJ EMS Council.

Dr. Nevins is a partner of Emergency Medical Associates and is a member of EMA’s Board of Directors.

•

35 years years of expertise exper x tise

•

Serving Ser ving patients patie ents in New Jersey, Jersey, New New York York and Pennsylvania, Pennsylvania, well as North Nor th Carolina Carolina and Rhode Rho ode Island as well

•

Dedicated Dedicated board-certified bo oard-cer tified emergency emerge ency physicians physicians integrate integ gra te into your your hos spital’s cultur e into hospital’s culture

•

Recognized Recognized for fo or clinical excellence, excellence, quality quality service ser vice and high patient satisfaction patient sa tisffaction

(877) 692-4665 5

info@EMA.net

www.EMA.net www .EMA A.net

PAGE 8

December, 2013

Hospital Newspaper - NJ

Ask An Expert Christopher J. O’Connor Executive Vice President, GNYHA Ventures, Inc., President, GNYHA Services, Inc. and President, Nexera, Inc.

The Password to Access Strategic IT Solutions?

Try G-P-O. To succeed in today’s healthcare system, information sharing across provider types and locations is essential—a task made easier by information technology. For years, hospitals have funneled resources into cutting-edge medical technology, but lagged behind in using IT to streamline processes and disseminate information. Hospitals are now challenged to bolster their IT systems—both hardware and software—to link the people and processes that affect cost, quality, and outcomes. With the capability to share data quickly and securely, as well as perform complex analytics, IT is vital to every hospital’s strategic plan.

The high price tag of IT investments warrants a clearly defined methodology to assess the value of the technology.

However, when making that assessment, the way in which the technology affects the organization’s overall healthcare delivery, not just the efficacy of a specific function (such as network management), should also be considered. IT projects are more likely to succeed when the following organizational and project features are in place: 1. A set framework to regularly assess organization-wide IT capabilities and investments 2. Realistic expectations and timelines for IT project implementation 3. Deployment strategies that include ample testing, training, and input from stakeholders other than IT (supply chain, clinicians, etc.)

4. Availability of baseline process performance measurements 5. Plans for ongoing IT measurement and reporting processes One of the reasons that IT implementation is complex is that oftentimes more than just internal factors are involved.

IT may require compatibility across systems and industries. There are also usage and security restrictions to be considered.

That's where a group purchasing organization can be indispensable. A GPO can help health organizations streamline the process of meeting their information technology needs, whether by aggregating volume to get the most competitive prices on personal computers or tablets, or by identifying the best data storage solutions that comply with essential regulatory standards. At GNYHA Services, in addition to offering contracts for services ranging from IT consulting to image management, we provide access to strategic technology solutions for e-procurement, staff scheduling, and even mobile device recycling. And our members can rest assured that their IT services meet HIPAA and other regulatory requirements. Our IT vendors provide secure data delivery and storage solutions (such as encrypted email)—all HIPAA compliant for data exchanged over the Internet—with detailed tracking and reporting capabilities for auditing purposes.

By providing the means for patients, providers, and other organizations to access vital data and communicate with each other, IT has the potential to impact all of healthcare’s main components, including clinical, financial, and operational processes. But you don’t have to wade into the deep end of IT alone: your GPO, with a strategic IT portfolio, can help hospitals and health systems access the most relevant, innovative, and secure IT services at the greatest possible savings.

Christopher J. O’Connor is Executive Vice President of GNYHA Ventures, Inc., the for-profit arm of the Greater New York Hospital Association, and President of two GNYHA Ventures companies: GNYHA Services, Inc., an acute care group purchasing organization, and Nexera, Inc., a healthcare consulting firm. Mr. O’Connor is Chair-Elect of the Association for Healthcare Resource & Materials Management (AHRMM).

Hospital Newspaper - NJ December, 2013

Achieve Optimal IT—SYNC to SAVE

From iPads to EHRs, hospitals are placing renewed focus on IT capital investments.

GNYHA Services helps providers keep pace with this dynamically changing industry. Our contract portfolio is built using member feedback to ensure that members achieve savings in every healthcare IT category.

Turn to GNYHA Services to sync systems with savings.

Call us today at (212) 246-7100.

555 West 57th St. I New York, NY 10019

Page 9

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December, 2013

Hospital Newspaper - NJ

Fund-Ex Provides Customized Financing Solutions to Healthcare Professionals

By Patrick Harrigan | Syracuse, NY

Today’s medical professionals face a myriad of challenges in their efforts to provide high-quality care. Change has become an industry constant and requires SK\VLFLDQV WR OHDUQ DQG DGDSW RQ WKH À\ Much of the conversation revolves around increased healthcare regulation and compliance requirements. While its long-term effects remain to be seen, the 13,000-page Affordable Care Act promises to bring about considerable change and uncertainty. From a technology standpoint, the push is on to implement EHR systems and demonstrate meaningful use. New HIPAA rules will soon require practices to have policies and procedures in place to ensure that patient health information is secure.

Change is also a major theme when it comes to patient interaction. As technology improves and information becomes more accessible, the methods by which patients gather information and interact with care providers will continue to evolve. While increased engagement can ultimately prove valuable as patients take a more active role in their health care, it will also require more time and attention from providers, not to mention DQ LQFUHDVHG ¿QDQFLDO LQYHVWPHQW In addition, many practitioners still face the day-to-day business challenges of running a practice. Physicians PXVW PDQDJH ¿QDQFHV FRPPXQLFDWH effectively and delegate responsibility ZKLOH PDLQWDLQLQJ D VWHDG\ ÀRZ RI SDWLHQWV 6WDII PXVW IHHO IXO¿OOHG DQG patients must feel comfortable to ensure a positive experience.

The frantic pace and ever-expanding task list can often mean that things get overlooked, impacting the long-term health of the practice. Debt can accumuODWH ZKLOH RI¿FH XSJUDGHV DQG PDQGDWRU\ technology updates can get pushed down the priority list. A medical professional’s WLPH LV DOUHDG\ OLPLWHG DQG ¿QGLQJ WKH UHVRXUFHV WR VHHN QHFHVVDU\ ¿QDQFLQJ can seem overwhelming.

Fund-Ex, LLC was founded with the simple goal of providing medical SURIHVVLRQDOV ZLWK DIIRUGDEOH ÂżQDQFLQJ solutions while minimizing the disruption of their day-to-day routine. “Healthcare professionals have made WUHPHQGRXV VDFULÂżFHV WR JHW ZKHUH WKH\ are today. They continue to work hard every day, and that means something to us,â€? said Albert Crawford, Owner and CEO of Fund-Ex. “That’s why we have built our business around them. We VWULYH WR SURYLGH D KDVVOH IUHH ÂżQDQFLQJ experience that helps achieve business goals and allows more time to focus on the mission of medicine—the patient.â€?

An unwavering focus on providing capital to healthcare professionals has helped Fund-Ex develop a thorough understanding of their needs, challenges and business cycles. This knowledge allows Fund-Ex to provide smart ÂżQDQFLQJ VROXWLRQV ZLWK XQSDUDOOHOHG VHUYLFH DQG HIÂżFLHQF\ DOORZLQJ SK\VLcians to get back to practicing medicine.

Fund-Ex can provide a custom, no-cost, no-obligation loan proposal in just

24 hours and healthcare professionals can get the capital they need in as few DV ÂżYH EXVLQHVV GD\V 7KH FRPELQDWLRQ of speed and competitive rates makes Fund-Ex an attractive and affordable option for healthcare professionals looking to put their practice in a better position looking forward.

Fund-Ex provides capital for a wide variety of commercial purposes, including business debt consolidation, working capital, expansion and improvement, practice acquisition/start-up/buy-in as well as real estate.

The Funding Expert for Healthcare Professionals www.fund-ex.com

|

877.851.9405

Hospital Newspaper - NJ December, 2013

Get the money you need in 5 days!

Spend more time with your patients and less WLPH VHHNLQJ ĹľQDQFLQJ As a lender that works exclusively with healthcare professionals, Fund-Ex strives to provide quick and

Custom proposal in 24 hours Loan won’t appear on personal credit

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Page 11

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December, 2013

HELP Program continues to make a difference They provide all of us with top quality patient care every day, so why shouldn’t they be taken care of.

Why shouldn’t hard-working nurses, caring doctors and their staff receive the same commitment?

Well, thanks to the Hospital Employee Loan Program (H.E.L.P.), they all do.

Sun Home Loans and Hospital Newspaper teamed up to create H.E.L.P. It’s been nothing less than a success, gaining notoriety in the community.

How could it not?

This innovative mortgage provides discounted mortgage rates designed for hospital employees and pre-qualifications for their next home or refinance.

In addition, there are many more benefits available to the healthcare services community through this program – including a complimentary evaluation of your particular financial situation.

Sun Homes Loans knows that as a healthcare professional, a doctor, a nurse, a physician’s assistant, your life is busy. We believe that you deserve nothing but the best service and programs. Our customer service – from initial inquiry up until the big day – closing – is first-rate.

“We are proud to work with Sun Home Loans and the healthcare community on such a great initiative,” said Joe Belsito, Publisher of Hospital Newspaper.

“Members of the hospital community are part of the core of our country. Putting together such a unique and value-added program for them to benefit from when buying a new home is a great way to show our appreciation and support. We are so happy that the H.E.L.P. program is flourishing.”

Sun National Bank provides a full-range of banking products and services, delivered by experienced bankers. Personal attention merges with world-class service and competitive products that meet the needs of today’s consumers and businesses. Sun National Bank believes that doing business in the community means being a part of it.

The healthcare services sector is, of course, a very important part of the fabric of any community.

That’s why Sun Home Loans and Hospital Newspaper is so proud to work with all of them.

Whether purchasing a new home or refinancing an existing one, the Sun Home Loans H.E.L.P. program is offered to members of the hospital community and their families. A H.E.L.P. program representative will assist you in making sure the process is cost-effective and works for you and your family. In addition, Sun National Bank provides a full-range of banking products and services, delivered by experienced bankers.

It’s the least we can do for people who care and do so much for all of us.

To receive more information about the program and its benefits, please contact Steven Testa at stesta@sunnb.com or call 973-615-9745. Sun National Bank Home Loans and Hospital Newspaper are not affiliated. All loans subject to approval. Certain conditions and fees may apply. Mortgage financing provided by Sun National Bank Loans, Equal Housing Lender.

Hospital Newspaper - NJ

Win an iPad! If you are a member of the hospital community, now is your chance to enter Sun Home Loans and Hospital Newspaper's contest to win a free iPad. Just to go our website at www.hospitalnewspaper.com and fill in the entry form.

Once you complete it, you will receive an email that requires you to confirm your email address. Once you do that you are entered. Hospital Newspaper will also be accepting applications at all conventions that it attends. A total of Five iPads will be given away so your chances to win are excellent. Sign up today to win today!

Hospital Employee Loan Program

Sun Home Loans, a division of Sun National Bank, is proud to serve the heroes in our community who dedicate their lives to serving the rest of us: doctors, nurses and other hospital employees.

That is why we teamed up with Hospital News to create the Hospital Employee Loan Program (HELP).

With a competitive mortgage rate and discounted fees, this program helps our community heroes purchase new homes or refinance existing homes.

Plus, the program comes with our pledge to get hospital employees in their new homes by their contract dates.

PROGRAM INFORMATION We understand that the current economic environment has created challenges to home ownership. Working with our own resources and Federal government programs we will create a solution that opens the path to home ownership.

The Hospital Employee Loan Program delivers these advantages: » A competitive mortgage rate, available specifically for hospital employees » Discounted fees » Personal service from program specialists » Our pledge to have you in your home by the contract date

COMMUNITY FOCUS Sun National Bank, a full-service provider of banking products and services, is dedicated to playing an active part in the communities we serve. We support a variety of organizations, events and programs whose goals are to make our neighborhoods a better place to live and work and improve the lives of those living around us. Hospital News is the leading provider of local news and information for doctors, nurses and other hospital staff.

Learn More To find out more about our Hospital Employee Loan Program, email stesta@sunnb.com or call 973-615-9745 to talk with our program specialist, Steve Testa (NMLS #460176), who will discuss your need and explain how the program could benefit you.

www.sunnb.com Sun Home Loans, Sun National Bank, and Hospital News are not affiliated. All loans subject to approval. Certain conditions and fees may apply.

Mortgage financing provided by Sun Home Loans, a division of Sun National Bank, member FDIC. Equal Housing Lender.

NMLS #429900

Hospital Newspaper - NJ December, 2013

PAge 13

Bergen Regional Medical Center honors six employees with the President’s Distinguished Merit Award Bergen Regional Medical Center (BRMC) honored six employees with the President’s Distinguished Merit Award for their outstanding customer service and dedication to patient care. The awardees received the honor during the hospital’s 15th annual Merit Awards Ceremony at Seasons in Washington Township, NJ. This year’s recipients include:

• • • • • •

Elizabeth Gooding joined BRMC 40 years ago and works a ward clerk.

Jennifer Purnell joined Bergen Regional in 2008 as an addictions counselor and is currently the Manager of the BRMC Access Center for Mental Health and Substance Abuse Services.

Debra Rausch, RN, has worked at BRMC for 35 years in the Behavioral Health Department and recently joined the hospital’s Education Department.

Srikanth Reddy, MD, began his career with Bergen Regional in July 2000 as a resident and joined the staff as a psychiatrist in 2004.

Victor Reyes joined BRMC in 2007 and works as a cook.

Michele Zerener, joined BRMC in 2009 and is the Assistant Director for the Long Term Care Pharmacy.

The BRMC President’s Merit Awards Program acknowledges employees who demonstrate outstanding service in their care towards patients’ well-being and service anniversary milestones. Honorees were nominated by their peers and supervisors and selected by an administrative committee.

About Bergen Regional Medical Center Bergen Regional Medical Center is both the largest hospital with 1,070 beds and the largest licensed nursing home in New Jersey. Located at 230 East Ridgewood Avenue in Paramus, NJ, BRMC provides a comprehensive set of quality services including Long Term Care, Behavioral Health Care and Acute Care to the Bergen County community and is a safety net provider for the underinsured and uninsured in the State of New Jersey. Bergen Regional has a full service emergency department, state of the art operating suites and more than 20 ambulatory specialty services available through the BRMC clinic. For more information, call 201.967.4000 or visit www.bergenregional.com.

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December, 2013

Hospital Newspaper - NJ

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PAGE 16

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December, 2013

Hospital Newspaper - NJ

Nurse’s Viewpoint

By Alison Lazzaro, RN

Hospital Newspaper Correspondent

Standing Your Ground Ever read the childhood story book, "If You Give a Mouse a Cookie?" As the story goes in this circular tale, once the mouse is given a cookie, the mouse asks for milk, and then continues requesting more and more. In nursing, sometimes it's challenging not to be pulled into this spiral. Patients push you to the limits, but ultimately it is important to do what is safe for the patient and to protect your license.

Take Jane Doe for example. A 23 year old "frequent flyer" patient with chronic pancreatitis is admitted to your unit. When you walk in to administer her medications, she tells you that all the other nurses gave her twice the dose that is ordered for Benadryl, rather than "wasting" half the bottle.

Jane Doe tests the limits and notices how busy you look. She is knowledgeable about the hospital system.

How do you stand your ground while caring for her with respect?

First off, take a deep breath and center yourself before entering the patient's room. If "PRN" medications were given during the previous shift, be sure to note the correct times they are due next. Writing down the time for the next scheduled dose for the patient can eliminate being called back into the room many times. This also provides the patient the ability to participate in her care by knowing when her medications are due and asking for them appropriately.

Clustering care is critical during a busy shift to keep you grounded. Avoid going into a patient room empty handed.

Instead, be ready to take a blood sugar, bring in a fresh pitcher of water and morning medications rather than going back and forth constantly. Multi-tasking these jobs will allow the patient to get more undisturbed rest and allow you a couple extra minutes to be fully present with your patient. These extra moments allow you use your time to connect with your patient.

Be an advocate for your patients. Speak up if you see your patient's pain regimen is not providing relief.

After twelve hour shifts, nurses know their patient better than anyone else on the treatment team and can detect subtle changes. Be persistent if your intuition tells you something is wrong because it can save lives.

Focus on one patient at a time. Nurses are constantly being interrupted with different tasks whether with a phone call, visitor, or call light. Take a moment to step back and concentrate on the patient you are working on. This will prevent you from charting on the wrong patient or giving an incorrect medication.

Standing your ground translates to caring for the mind, body, and spirit of your patient while being true to yourself as a nurse. Jane Doe's manipulative behavior may just be her way of retaining some sense of control in the uncertain hospital environment. Take a moment to set an intention at the start of your shift and know that patients are just looking for a caring and knowledgeable nurse to help them.

Be mindful when talking to your patient rather than scrambling to the next task. Remember the power of taking a deep breath whenever things seem to get overwhelming. Standing your ground in this holistic perspective can prevent burnout and promote healing.

Hospital Newspaper - NJ December, 2013

Page 17

education & careers Atlantic Health System and Montclair State University form partnership to promote arts in health care, education Atlantic Health System and Montclair State University have announced a partnership to promote healing arts in health care and education through research.

Through the robust services of Atlantic Health System, one of the largest non-profit health care systems in New Jersey and the academic capabilities of Montclair State University, one of the state’s foremost learning institutions, the partnership will offer opportunities to research and develop the ways that arts and health complement each other.

Atlantic Health System is comprised of Morristown, Overlook and Newton medical centers and Goryeb Children’s Hospital. Montclair State University’s College of the Arts is a state-designated “Center of Excellence in the Arts,” and is home to the George Segal Gallery and the Creative Research Center.

William Neigher, Vice President, System Development, and Chief Strategy Officer for Atlantic Health System, noted that there are many opportunities for arts to play an important role in healing, both in and out of hospital settings.

“A healing culture is essential for us to achieve our mission,” Neigher said. “People come to us in some of the most difficult moments of their life. We can make connections with them through arts and music not only to aid them in those moments, but to help them live healthier throughout their lives.”

“The partnership between Atlantic Health System and Montclair State University has the very rich potential to illuminate new pathways to well-being,” said Montclair State University President Susan A. Cole. “The goal of that partnership is quite simply to become a leader in arts and health care and help future leaders to advance in both of these fields.”

Through the partnership, health care and academic professionals will collaborate to examine the ways art can contribute to medicine and vice versa – for instance, the way art therapy can be used to help patients being treated for Alzheimer’s disease, or the way sports medicine might assist dancers and performers.

The partnership will also enhance academic programs and provide a new outlet to bring together students studying health care or art to explore both subjects. This includes:

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PAGE 18

December, 2013

Hospital Newspaper - NJ

education & careers Lourdes Health System recently named Sheila Cooper, RN, Same Day Surgery unit, Lourdes Medical Center of Burlington County; and Med/Surg nurse Jennifer Anderson, RN, Our Lady of Lourdes Medical Center, as its DAISY Nursing Award winners for the third quarter of 2013.

The award is presented in collaboration with The American Organization of Nurse Executives. It is part of the DAISY (Diseases Attacking the Immune System) Foundation’s program to recognize the super-human efforts nurses perform every day.

Cooper, of Willingboro (a native of Newark), was honored for her work ethic and professionalism.

One of her nominators stated,

“Sheila has the ability to interact effectively with all departments and has an enthusiastic spirit which creates a pleasant and enjoyable work environment.” Another nominator said, “Sheila provides leadership and innovative ideas, such as the installation of lockers for patient belongings. Sheila steps up to the plate and without a doubt is an excellent, caring, professional nurse that other nurses look up to.”

Anderson, of Medford Lakes, was honored for patient-centered care and her ability to comfort patients and their family members. One nomination stated, “We had a patient who was suffering, experiencing physical, emotional and spiritual pain. Jennifer, as busy as she was, made him and his family feel as if

they were the center of all that she needed to do. As she knelt by his bed and just held his hand, she embodied the true Lourdes mission. Jennifer is who I would want at my bedside if I am ever sick, in pain and afraid. You have the best of the best in Jennifer.

I am privileged to have shared this patient’s care with her.”

The DAISY award is presented to a nurse from each of the Lourdes hospitals every quarter.

The DAISY Award was established in 2000 by the Barnes family in honor of J. Patrick Barnes, who died at 33 of an auto-immune disease. The care Patrick and his family received inspired the family to thank nurses nationwide for making a profound difference in the lives of their patients and families.

photos provided

Lourdes Health System names Nursing Award Winners

Sheila Cooper, RN

Jennifer Anderson, RN

Holy Name Medical Center’s Dr. Kutzleb receives Mary Anne Rooney Essence of Nursing Award Judith Kutzleb, DNP, RN, CCRN, CCA, APN-C, received the Honor Society of Nursing’s, Mary Anne Rooney Essence of Nursing Award presented by New Jersey Consortium Sigma Theta Tau International (STTI), the nursing honor society. She has earned this prestigious award for her contributions to the profession of nursing, her dedicated mentorship to those in the field, and her international mission work.

Dr. Kutzleb is the Vice President, Advanced Practice Professionals at Holy Name Medical Center, and Associate Professor and Coordinator of the Advanced Nursing Program

Track in the graduate program at Fairleigh Dickinson University in Teaneck, New Jersey.

In addition to this accomplishment, Dr. Kutzleb has also been honored by the Department of Health and Human Services with a certificate of recognition for Excellence in Nursing; nominated by the graduate student body at Fairleigh Dickinson University for the Outstanding Teacher Award; named a finalist in the New York/New Jersey Nursing Spectrum’s Nurse of the Year; and received the Governor’s Award in the Educator Category.

Unique Recruitment Opportunity Hospital Newspaper believes that high school students should be informed about potential healthcare careers. Special career sections will be placed in your local high schools, medical schools, colleges and nursing schools.

This is your opportunity to display opportunities for: Faculty/Physician Nursing Administrative Support Positions Clinical Care

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Contact Jim Stankiewicz for more information. tel: 845-534-7500 x219 jim@hospitalnewspaper.com

The Mary Anne Rooney Essence of Nursing Leadership Award, named in memory of a nurse leader, is given to an individual who demonstrates special interest and guidance to a colleague or a student. Those honored share resources with their mentees for their professional growth and development.

This sustained mentoring relationship fosters talent, and develops nurse leaders through a personal connection of caring, inspiration, and encouragement to accomplish these goals.

Hospital Newspaper - NJ December, 2013

PAge 19

Power of music motivates young woman with disabilities to express herself creatively

Music therapist Sabrina Deutsch congratulating Natalie after her performance.

The annual Matheny Medical and Educational Center talent show is a creative forum that enables students and patients with disabilities to express themselves and feel empowered to share their gifts and talents.

Nowhere was that more evident than in the performance this year by adult patient Natalie Tomastyk, who decided to sing “Brave”, a song made popular by singer-songwriter Sara Bareilles. Through the process of learning the piece, according to music therapist Megan Chappius, Natalie decided she also wanted to play the piano.

“Alternating between singing and playing was a new skill for Natalie to learn,” said Chappius, “but she was determined to do it. Fortunately,

she very quickly and easily mastered the skill. She never grew tired or frustrated, and she was very motivated.” In addition to learning the lyrics, Natalie had to work on her breath support and vocal phrasing.

“It was important,” Chappius added, that she identify with the artist in her and tap into her own unique personal creative expression. With that in mind, we focused on her emotional expression and connection to the message of the song when performing it. The song’s message is very empowering, about being brave and believing in yourself.”

In order for Natalie to learn the piano, Chappius marked off specific notes that she could play on the keyboard that were in the key of the

Natalie and Megan practicing in the music room.

song. “Good eye-hand coordination was needed to play the marked notes with accuracy,” Chappius explained. “Each week, she increased her speed and accuracy when playing.” Natalie was “a little nervous” before the performance, but afterwards, she said: “I am proud of myself, and I feel good.”

The talent show was held in October in the Robert Schonhorn Arts Center at Matheny, a special hospital and educational facility in Peapack, NJ, for children and adults with medically complex developmental disabilities. Music therapists at Matheny use various types of music to positively impact students’ and patients’ cognitive, physical, emotional and social skills, helping

LIFE at Lourdes participant celebrates 100th birthday

provided

Adele Schlossberg, an avid bird lover and a participant at LIFE at Lourdes – a unique program based in Pennsauken, NJ, that assists elders to live safely at home while providing them with a team of healthcare experts – celebrated her 100th birthday with a party that included her family and her LIFE at Lourdes co-participants and staff, as well as Angel, Adele’s 30-year-old pet parrot.

One-hundred-year-old Adele Schlossberg blows out 100 candles with the help of family members (l – r) Caleb and Shira Keet, Janette Ritter, and Liam and Jadyn Keet.

them realize their potential in society. Activities and techniques include improvisation, rhythm,

photos provided

songwriting, songs, chants, instrumental activities, live music and recorded music.

PAGE 20

December, 2013

Hospital Newspaper - NJ

Retiring couple leave a 40-year legacy at Raritan Bay Medical Center Employees at Raritan Bay Medical Center (RBMC) since 1971 and 1973 respectively, Linda and Erich Kreher have certainly seen healthcare evolve and both have contributed to the growth of the medical center over four decades. On a personal side, this 39-year married couple has their second family at the medical center to thank for getting them together in the first place.

“It’s true there was a little matchmaking involved,” recalls Linda, who spent her RBMC career in the Communications Department as a systems administrator. Erich, who is retiring as the medical center’s Senior Vice President and General Counsel, was first employed at RBMC as a supervisor in the microbiology lab. “The lab, where pathology studies were conducted, and the Communications Department shared the same hallway. Passing by every day, I couldn’t help but

notice this very attractive woman in Communications. Eventually, my boss and my to-be wife’s boss said, ‘Why don’t you just ask her out? It’s not like you have to marry her.’”

The couple did in fact marry in 1974 and Linda and Erich continued to work at Raritan Bay. That same year, Erich began night school at Seton Hall University Law School, graduating four years later and eventually becoming the medical center’s Director of Legal and Risk Management. “The titles have changed over the years,” said Erich, “and the responsibilities have increased and the scope of work has certainly grown as healthcare has become more complex. I’ve been involved in several building projects, the development of our corporate compliance program, the formation and operation of our captive insurance company, and the beginning of our enterprise risk management program.”

Linda chuckles when she recalls that for many years, some RBMC staff didn’t even know the two were married. “We never had lunch together,” said Linda, “and believe it or not, we did not discuss work when we got home.

With a growing family, we had so much else going on when we weren’t at the hospital.”

Linda’s department manages phone operators, internal phone systems, physician practice answering services and similar communications areas throughout the medical center. “As RBMC has grown, so has our department,” said Linda. “With new technology and many expansions, the work has always stayed interesting and exciting.” Both Linda and Erich agree that they have made many close friends over the years at Raritan Bay Medical Center. “It’s been a good run,” says Linda, “and now we are looking forward to a new phase of our lives together.”

Erich and Linda Kreher at the Harbor Lights Ball.

Nearly forty years, two sons and two grandchildren later, Linda and Erich will soon take leave of their caring friends and co-workers at RBMC. The former Lincroft residents

provided

are counting the days until they depart for South Carolina to enjoy sunny days filled with golf, gardening and visits from children and grandchildren.

Hunterdon Wound Care Center recognized for healing wounds and changing lives Hunterdon Medical Center physician, leaders and clinicians gathered to celebrate the Center of Distinction Award, which was given to the Hunterdon Wound Healing Center by Healogics, Inc., the nation’s largest provider of advanced would care services. The Center has achieved outstanding patient outcomes for twelve consecutive months, including patient satisfaction over 98%, a 91% wound healing rate within 24 median days to heal, among other quality outcomes.

According to Donald Pinner, Senior Vice President of Community Health Improvement and Chief Operating Officer for Hunterdon Regional Community Health, “Our Wound Care Center heals chronic wounds of patients who might otherwise experience an amputation or other life-threatening conditions. We are proud to provide this specialized and needed service to our community.”

The Hunterdon Wound Healing Center specializes in the treatment of chronic wounds and offers hospitalbased outpatient wound care as well as disease management and diabetes care. It offers leading edge therapies including hyperbaric oxygen therapy, the use of vascular studies, tissue culturing and pathology, revascularization, skin grafting and clinical or surgical debridement.

The Hunterdon Wound Healing Center is a member of Healogics Network of over 500 centers, which provides access to benchmarking data and proven experience treating over two million chronic wounds.

“We’re honored,” Bruce Kostecka, Program Director, Hunterdon Wound Healing Center. “It’s a privilege to be part of a great collaborative effort between the hospital, physicians, and Healogics. Together, we are able to heal patients in our community, getting them back to living happy, healthy lives.”

The Hunterdon Wound Healing Center is located at the Wescott Medical Arts Center, 9100 Wescott Drive in Flemington (next to the Hunterdon Medical Center).

For more information, call 908-237-6950 or visit www.hunterdonhealthcare.org.

provided

Employees of the Hunterdon Wound Healing Center and administration of Hunterdon Healthcare gather for a picture (pictured left to right): Liz Neveris, Debra Spayd, Donald Pinner, Senior Vice President of Community Health Improvement and Chief Operating Officer for Hunterdon Regional Community Health, Nada Riser, Healogics, Robert P. Wise, President and Chief Executive Officer for Hunterdon Healthcare, Bruce Kostecka, Program Director, Hunterdon Wound Healing Center, Michelle Allegro, Christine Piancone-Wolf, Janice Carroll, Rose Marie Comunale and Dawn Eick.

Hospital Newspaper - NJ December, 2013

Power wheelchairs create independence When Amanda Anastasia was about eight years old, she needed a new power wheelchair. “At the time,” her mother Sam recalls, “she had been driving her wheelchair with a scanner. It was a very slow process. The therapists at the Children’s Center for Therapy, where she was going to school, recommended that we visit the seating and mobility clinic at the Matheny Medical and Educational Center.

They tested her out using head array, and she did fantastic. She learned to drive with her head.

What a difference it made!”

Amanda, now 20, and her brother, Daniel, 15, have a condition called Aicardi-Goutieres, a syndrome that affects all of their motor functions. They have been in wheelchairs virtually their entire lives, but, since that visit about 12 years, all of their wheelchair and equipment needs are managed by Matheny, a special hospital and educational facility in Peapack, NJ, for children and adults with medically complex developmental disabilities.

“When Amanda got her first power wheelchair,” her mother recalls, “I didn’t feel the salesperson had good knowledge of the product. She just suggested a chair and that’s kind of what we went with.

At Matheny, they have expert knowledge about products and

seating positioning. Because of the population that lives at Matheny, they have so much real life experience.” Her children, she points out, “live in their chairs. They may go to a different setting, but they’re still in their chairs.” The Matheny therapists, she says, “know their movements, their tone, where they’re tight, where they’re not tight. If there’s a problem, they find a way to solve it. They have creative ideas; they think outside the box.”

The transition from a manual to a power wheelchair, Anastasia emphasizes, is critically important. “A power chair,” she says, “gives them some independence, freedom.

They can drive from room to room.

The chairs elevate, they tilt, they recline. So, they can change their position themselves. They don’t have to wait for somebody or try to explain to somebody where they want to move.

The seating and mobility clinic at Matheny is part of the Matheny Center of Medicine and Dentistry.

The clinic team of therapists and rehabilitation technicians strives to meet the needs of each individual by providing the perfect match of assistive technology services and products to provide the highest level of health, function and quality of life. For more information, call (908) 234-0011, ext. 722.

PAge 21

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From left, Amanda, Sam and Daniel Anastasia

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PAGE 22

December, 2013

Hospital Newspaper - NJ

St. Joseph’s 37th Annual Charity Ball Salutes George McLoof for Community Involvement George McLoof has been in the real estate development business his entire professional career. Most recently through Longstreet Development, the company he founded in 1991, he has redeveloped historic industrial mill structures into urban mixed-use residential and commercial properties, and manages them through Longstreet’s affiliate company, Alexa Management Corp.

Longstreet has joint ventured with not-for-profit organizations including New Jersey Community Development Corporation, New Jersey Community Capital, Concerned Parents for Head Start and Paterson Coalition for Housing to develop and manage affordable housing with a concentration in the Paterson area.

George is a stalwart friend of St. Joseph’s, who began supporting the Hospital’s Charity Ball in the 1980’s and joining the Medical

St. Joseph’s Healthcare System in Paterson, New Jersey, proudly presented George McLoof, a steadfast and longstanding member of the St. Joseph’s family, with the 2013 William F. Johnson Award at St. Joseph’s Regional Medical Center’s 37th Annual Charity Ball, hosted by the hospital’s Foundation. Mr. McLoof was recognized for his exceptional commitment to the Hospital and the community.

Center’s Foundation Board in 1991.

He has served continuously since that time and holds the position of Immediate Past Chair after serving a four year term as Chair of the Board from 2009 – 2013. Prior to that, he served as Vice Chair and Treasurer and also chaired the Charity Ball Committee. Additionally, he has served on the Foundation’s Real Estate, Golf, Christmas Concert and Cooking for Kids Committees, as well as volunteered countless hours as the President of the Willowbrook Condominium Association, lending his expertise to help the Foundation manage this asset. He currently serves on the Executive, Finance, By-Laws and Nominating Committees. A lead donor to the ‘St. Joseph’s is the Future’ campaign, he also serves on the Healthcare System’s Campaign Steering Committee.

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George has received awards from various civic organizations and Chambers of Commerce for contributions to historic preservation, urban revitalization and affordable housing. His community activities have included the Board of the United Way of Passaic County, the Board of Education and the Master Planning and Zoning Committee in Midland Park, the Ramapo District of the Northern New Jersey Boy Scout Council and the Advisory Board of Paterson Habitat.

A native of Franklin Lakes, George obtained his undergraduate (B.A.) degree from Yale University in 1972 majoring in mathematics and philosophy and an M.B.A. from the Stern School of Business at New York University in 1975 majoring in finance.

His three children, Gwendolyn (Feinhals), Laurelei and Theodore are accomplished educators in grades

ranging from kindergarten through the post graduate level.

The St. Joseph’s Regional Medical Center Foundation is the fundraising arm of St. Joseph’s Regional Medical Center and St. Joseph’s Children’s Hospital in Paterson, both components of the St. Joseph’s Healthcare System. Sponsored by the Sisters of Charity of Saint Elizabeth, St. Joseph’s Healthcare System also encompasses St. Joseph’s Wayne Hospital, a division of St. Joseph’s Regional Medical Center, in Wayne; St. Vincent’s Nursing Home in Cedar Grove; and Visiting Health Services of New Jersey in Totowa. The System offers a full spectrum of leading edge medical and surgical services.

For more information about St. Joseph’s, please visit our website www.StJosephsHealth.org or call 877.757.SJHS (7547).

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Hospital Newspaper - NJ December, 2013

Page 23

Higher Nurse Staffing Levels associated with lower odds of readmission penalties Under the Affordable Care Act (ACA), hospitals that have excessive 30-day readmissions for Medicare patients admitted for heart attacks, heart failure or pneumonia are subject to financial penalties in the form of reduced payments from the Centers for Medicare and Medicaid Services (CMS). The Hospital Readmissions Reduction Program (HRRP) is intended to reduce preventable readmissions and is estimated to reduce hospital payments by roughly $280 million in fiscal year 2013. According to a new study published in the October issue of Health Affairs, increasing nurse staffing levels may help hospitals avoid these penalties.

The study, led by Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, associate professor at the University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, reveals that hospitals with higher nurse-to-patient staffing ratios have lower odds of being penalized for excessive readmissions under HRRP. McHugh and his colleagues examined nurse staffing levels and data on readmissions penalties for 2,826 hospitals in the U.S. They found that hospitals with higher nurse staffing had 25 percent lower odds of being penalized than similar hospitals with lower nurse staffing ratios. Hospitals with higher nurse staffing levels also have 41 percent lower odds of receiving the maximum penalty for readmissions, compared with hospitals with lower staffing. The researchers estimate that each additional nurse hour per patient day is associated with 10 percent lower odds of receiving penalties under HRRP. The research team noted that higher staffing levels reduce nurses’ workloads, which allows them to work more effectively.

“Nurses are responsible for many activities associated with reducing readmissions, including coordinating care, overseeing care in the hospital, planning for patients’ discharge from the hospitals, and educating patients and their families about what to do when they return home,” said McHugh. “It’s rather intuitive that when they have adequate staffing and resources to carry out these activities properly, readmission rates decline. This study strongly supports the idea that nurse

staffing is one key component of health care delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions.”

The research team also included Julie Berez, an undergraduate student and research assistant at the Center for Health Outcomes and Policy Research at the University of Pennsylvania, and Dylan Small, PhD, associate professor of statistics, Wharton School, University of Pennsylvania.

McHugh is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, and was

one of only 12 nurse educators across the country selected in 2011 to participate in the program and to receive a three-year $350,000 grant to conduct research. The goal of the RWJF Nurse Faculty Scholars program is to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to young faculty. It is funded by RWJF and administered

through the Johns Hopkins University School of Nursing. It is directed by Jacquelyn Campbell, PhD, RN, FAAN, who is the Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing. The program is now in its fifth year. To learn more, visit www.nursefacultyscholars.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to

identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org. Follow the Foundation on Twitter www.rwjf.org/twitter or Facebook www.rwjf.org/facebook.

PAGE 24

December, 2013

Hospital Newspaper - NJ

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Bernstein & Associates, Architects Founded in 1990, Bernstein & Associates, Architects, specializes in the design and construction of hospital and healthcare facilities.

Our focus: high-quality design, excellent service, and client satisfaction.

We have worked for over 100 hospitals and another 200 private healthcare facilities, across the United States. Our project types have included all hospital and healthcare service groups, including: Adult Day Care, Alcoholism Treatment Facilities, Ambulatory Surgery Centers, Assisted Living, Cancer Centers, Cardiac Cath, Cardiology, CCU/ICU, Clinics, Coronary Care, Dental, Dermatology, Dialysis Clinics, Doctors Offices, Drug Treatment Facilities, Elder Care, Employee and Student Health Support Services, Emergency Departments, Emergency Preparedness, Endoscopy, ENT, Expert Witness, Group Practices, Hospices, Hospitals, Infectious Disease, Information Systems, Intensive Care, JCAHO Survey, Joint Commission Survey, Laboratories, Master Plans, Medical Offices, Medical Equipment, Medical Libraries, Medical Records, Neurology, Nursing Homes, Ophthalmology/Eye Center, OB/Gyn, Orthopedic, Pain Care Facilities, Pathology, Patient Safety Consulting Services, Pediatric, Pharmacy, Physical Fitness and Sports, PT/OT, Primary Care Programs, Psychiatric, Radiology, Rehabilitation, Senior Citizen Facilities, Sleep Centers, Social Services, Statement of Conditions, Surgical Suites and Ambulatory Surgery Centers, Urgent Care Centers, and USP 797 Consulting Services.

The firm's projects have won design awards from Progressive Architecture, Architectural Record, and the Architectural Woodworking Institute, and have been published in Advance, Health Facilities Management, Medical Technology Today, Bio/Technology, Progressive Architecture, Architectural Record, Design Solutions, Hospitality Design, Sound and Communication, Contract Design and Hospital Newspaper.

Architectural Services include: programming, planning, design, construction documents, bidding and negotiation, and construction administration.

The firm also offers sustainable or “green” healthcare design. The firm has a number of LEED-accredited professionals, has successfully completed numerous green healthcare projects, and has published articles on “Greening the Healthcare Environment”.

Project Management (or Owner’s Representative Services) is offered as a stand-alone service through our affiliated project management company, Empire Projects, Inc. (www.empireprojects.com).

Bernstein & Associates, Architects - PLLC 1201 Broadway - #803, New York, NY 10001 Contact: William N. Bernstein, AIA Managing Principal Tel: 609-309-7005 Fax: 609-309-7006 wb@bernarch.com NEW YORK - HARTFORD - PRINCETON

The Wedgie Pelvic Exam Wedge provides fast, comfortable pelvic exams in the ER, Radiology, SANE and Women’s Health. It is a much more comfortable than using a hard bedpan. The 6" height of the Wedgie lifts the patient's pelvis significantly higher then a bedpan, thus allowing physicians to perform a better exam. The Wedgie’s unique cutout design allows the physicians to maneuver their speculum in all directions without interference. The Wedgie support patients weighing up to 350 lb. It is made of a medical grade foam and an anti-microbial, anti-bacterial, and stain resistant medical grade vinyl cover. It can be cleaned with standard disinfectant products. Optional: disposable one-time use protective covers and room wall holders are available.

COMMUNICATION SkILLS Aspirin for Your Language Headache!

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Join BlueSteps today to put your resume and confidential careerprofile at the finger tips of over 8,000 of the world’s top executive recruiters, including hundreds who specialize in healthcare and life sciences recruiting. In addition to a unique connection to the executive search community, BlueSteps also provides a suite of proactive career management tools including: • a free resume review and career consultation • access to the International Executive Search Firm Directory • exclusive information on hundreds of active executive searches • online brand management tools • career management content and events specifically for senior-level executives As a service of the Association of Executive Search Consultants, you can rest assured that your career details will be confidentially and securely managed within BlueSteps. Unlike other mass job boards, only the highest caliber executive search consultants (all members of the AESC) will have access to your BlueSteps profile. Each year, AESC members recruit for over 70,000 of the highest level executive positions globally, many of which are never advertised publically.

CONTRACT/PRACTICE MANAGEMENT SERVICES

...and more Language Directions can help doctors, nurses, technical, and administrative staff to communicate more effectively between each other, patients, and their families

www.languagedirections.com Contact Donna Clark 1-888-554-8848 donna@languagedirections.com

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Contact Jim Stankiewicz to find out how your organization can be featured in our Resource Directory.

845-534-7500 ext.219 Fax: 845-534-0055

Online Directory available at www.hospitalnewspaper.com

HOME MORTGAGES Gateway Funding specializes in mortgage options to the healthcare industry.

We understand the nuances involved with obtaining mortgages for physicians, nursing staff, residents, or general staffing.

You’re busy, we know it. Your unique, we get it. You need financing for a home, we provide it.

One call or email to our experienced, licensed and fully trained loan officers, will put your mind at ease.

We can provide No Cost Pre-Approvals prior to looking for a home, and highly competitive rates and fee’s once you do find your dream home!

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Hospital Newspaper - NJ December, 2013

PaGe 25

MONOC & Newark Beth Israel Medical Center Simulation team wins Regional SimWARS Championship MONOC Mobile Health Services is proud to be part of the wining 2013 NY/NJ Regional SimWARS championship team. The annual competition was hosted by North Shore LIJ Health System in New York and held at the Center for Learning and Innovation at the Feinstein Institute for Medical Research.

Paramedic Wendy Wright from MONOC competed on a team with physicians and a nurse from Newark Beth Israel Medical Center’s Emergency Department.

SimWARS is double-elimination competition that challenges clinical interdisciplinary healthcare teams to compete against each other in simulated patient scenarios. Each team’s performance was reviewed by an expert panel examining the areas of teamwork, communication, and

clinical decision making. Then, the audience voted on the winner of each case using an audience response system based on their direct observation of the panel’s input.

Vince Robbins, MONOC’s President and CEO said, “We couldn’t be prouder here at MONOC. This win just reinforces that the hard work and dedication our staff puts forth to achieve clinical excellence is not only evident to our patients but to others in healthcare.”

MONOC works closely with Newark Beth Israel Medical Center on a number of ventures including their residency program and clinical research projects.

Additionally, physicians from their EMS Fellowship program ride as prehospital physicians on MONOC’s MD-1 emergency response vehicle.

provided

Pictured from left to right: Wendy Wright, Paramedic; Crescencia Daquipil, RN; Joseph Kotora, DO; Gia Mehrtens, MD; Noah Pores, MD

EMERGENCY MEDICINE UPDATE CME 2013 Conferences 9/23-26 Las Vegas, Nevada

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2014 Conferences 1/20-23 Duck Key, Florida

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page 26

December, 2013

Hospital Newspaper - NJ

RESOURCE DIRECTORY extended caRe & aSSiSted living daUgHteRS oF iSRael Daughters of Israel is a multi-faceted, stateof-the-art skilled nursing facility offering the most modern and comprehensive services available including: • • • • • •

Sub-Acute Rehabilitation Long-Term, Skilled Nursing Care Alzheimer’s Care Hospice & Palliative Care Respite Stays The Charles Bierman Home Senior Housing with Assistance • The Sarah & Aaron Franzblau Institute for Continuing Education Our team of skilled and dedicated professional staff deliver the highest quality of care for our 300+ residents. Services provided include: round-the-clock professional nursing care; 24hour medical coverage by board-certified geriatricians; on-site synagogue with full-time rabbinical services; a full range of stimulating and innovative recreational activities; on-site beauty salon, barber shop, work activity center, gift shop and coffee shop; spacious dining rooms, auditoriums, lounges and outdoor patio areas.

Our sub-acute rehabilitation facility, which functions as a separate unit within the Home, features a spacious gym with state-of-the-art equipment and comfortable recovery suites with luxury amenities.

Semi-private and private rooms are available at Daughters of Israel. The facility is covered

by Medicare, Medicaid, commercial insurances and private payment. Daughters of Israel is a beneficiary agency of United Jewish Communities of MetroWest, N.J. 1155 Pleasant Valley Way, West Orange, NJ 07052 www.doigc.org Contact: Adena Twersky, Director of Admissions Tel: 973-400-3307 Fax: 973-731-8364 atwersky@doigc.org

HoSpitalS BeRgen Regional Medical centeR, l.p.

Located in Paramus, Bergen Regional Medical Center is the largest hospital in New Jersey dedicated to serving the residents of Bergen County and surrounding communities. With 1000+ beds and 1,500 staff members, the hospital specializes in Behavioral Health Services, which include child and adolescent, adult and geriatric psychiatric treatment. Long Term Care Services provides a scope of services, which far exceeds that offered in a standard nursing home. As a full service accredited medical center, we provide wound care, surgical care, cardiac care, rehabilitation services, respiratory care unit which includes ventilator dependent residents, Korean care services and an acute care unit all under one roof for our residents. The hospital excels in the treatment of substance abuse.

The hospital offers detoxification, 21-day rehabilitation program, outpatient services, and treatment for the mentally ill and chemically addicted. Our Acute and Ambulatory Services offers same day surgery, medical and specialty clinics and state-of -the-art operating suites. www.bergenregional.com Tel. 201-967-4000

Medical Billing Cape Medical Billing (CMB) is your single source billing provider for curing undetected “revenue leakage” that plagues today's healthcare practices. CMB has been in business for 22 years and is uniquely qualified to help your medical practice reverse “revenue leakage” with fast, efficient, innovative and customized billing programs.

We offer personalized and cost effective service with 92.9% of charges paid upon the first submission! We accomplish this everyday by utilizing our “state of the art” billing software and paying close attention to critical detail used to match and process data. We also pride ourselves on significantly reducing days in accounts receivable by deploying aggressive and consistent follow-up procedures. Our technology, expertise and personal approach drive our billing practices and produce unparalleled results for our clients.

Are you currently doing billing in house and considering outsourcing? No problem, we can integrate our technology with your current EMR software package and help you convert your medical services to consistent cash flow! Our billing specialties: Cardiology, Internal Medicine, Podiatry, Family Practice, General Surgery, Pathology, Infectious Disease, Gastroenterology, OB/GYN, Neurosurgery, Urology, Trauma Surgery, PT/OT, Mental Health and Ambulance.

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contact Jim Stankiewicz to find out how your organization can be featured in our Resource directory.

845-534-7500 ext.219 Fax: 845-534-0055

Online Directory available at www.hospitalnewspaper.com

Learn What You Must Do To Protect Your Workers' Compensation And Disability Rights!

Do Not Make These Mistakes That Can Cost You Benefits

1. You must report the accident or injury as soon as possible, even if you might not lose time from work or need immediate medical care.

2. Report all injuries to all body parts, no matter how minor they may seem. If you do not report it and the injury gets worse over time, the job may deny benefits.

3. Remember, you are entitled to treatment and benefits even if you have previously injured the same body part in a prior accident.

Do not let the job tell you different.

4. Your doctor controls the treatment, not risk management. If you need an MRI and the job will not approve it, the experienced attorneys at BAGOLIE FRIEDMAN can fight to get it approved at no cost to you.

5. When you are released from treatment, you may be entitled to money for your injury and disability. You may also collect for repetitive stress, cumulative trauma, cancer, hearing loss & hepatitis.

6. Contact Attorneys Ricky Bagolie or Alan Friedman now for a confidential and free consultation and to discuss your workers' compensation and disability rights. There is no fee if there is no recovery call toll FRee 1-866-333-3529 (After Hours / Emergency Number 201-618-0508) Bagolie FRiedMan, llc Workers' compensation & disability attorneys The Five Corners Building 660 Newark Avenue - Jersey City, NJ 07306 (201) 656-8500 790 Bloomfield Avenue - Clifton, NJ 07012 (973) 546-5414

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HQ Location: Cape Medical Billing 5 Locust Lane P.O. Box 670 Cape May Court House, NJ 08210 Office: 609-465-8900 Fax: 609-463-8106 www.capebilling.com

apparatus Campbell Supply company www.campbellsupplyco.com expositions Abilities Expo www.abilitiesexpo.com financial Institutions Healthcare Employees Federal Credit Union www.hefcu.com home care specialists Comprehensive Home Care www.homecarenj.com hospitals Children’s Specialized Hospital www.childrens-specialized.org Matheny Medical & Educational Center www.matheny.org

internet address directory Meridian Health www.meridianhealth.com medical equipment & products TSK Products, Inc. www.tskproducts.com

Hospital Newspaper - NJ December, 2013

Page 27

67th Annual PostGraduate Assembly in

Anesthesiology Friday - Tuesday December 13 - 17, 2013 Marriott Marquis New York

Program and Registration Materials: m m m m m m m m m

Internationally Renowned Speakers Scientific Panels & Focus Sessions Hands-on & Interactive Workshops Mini Workshops Medically Challenging Case Reports Problem-Based Learning Discussions Scientific Exhibits Poster Presentations Technical Exhibits

ONL I NE R E GI ST R AT I ON :

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Resident Research Contest Pre-PGA Hospital Visits 3,500 Anesthesiologists in Attendance More than 6,000 Registrants New York City Tours Holiday Shopping Jazz Clubs Broadway Shows Opera

www.nyssa-pga.org Featuring programs in conjunction with:

Sponsored by: The New York State Society of Anesthesiologists, Inc.

The New York State Society of Anesthesiologists, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Up to 46.5 AMA PRA Category 1 CreditsTM

PAGE 28

December, 2013

Hospital Newspaper - NJ

Calling All Emergency Responders

When every second counts...

Count on NitroMist

®

NitroMist provides fast, effective symptom relief.

NitroMist provides a consistent dose with each metered spray.* NitroMist offers secure storage, ensuring potency for up to 36 months from date of manufacture.† Available in 90 & 230 spray bottles.

For product samples, patient educational material, and the NitroMist ER Box (Shown), Go to: www.NitroMistPro.com Now covered on UnitedHealthcare.

Check with your GPO for low contract pricing. For additional information, please contact us at info@akrimax.com BRIEF SUMMARY NitroMist® (nitroglycerin) lingual aerosol Rx Only INDICATIONS AND USAGE– NitroMist is indicated for acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.

CONTRAINDICATIONS– PDE5 Inhibitor Use: Administration of NitroMist is contraindicated in patients who are using a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5), as PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates. Severe Anemia: NitroMist is contraindicated in patients with severe anemia. Increased Intracranial Pressure: NitroMist is contraindicated in patients with increased intracranial pressure. Hypersensitivity: NitroMist is contraindicated in patients who have shown hypersensitivity to it or to other nitrates or nitrites. Skin reactions consistent with hypersensitivity have been observed with organic nitrates. WARNINGS AND PRECAUTIONS– Tolerance: Excessive use may lead to the development of tolerance. Only the smallest number of doses required for effective relief of the acute anginal attack should be used. As tolerance to other forms of nitroglycerin develops, the effect of sublingual nitroglycerin on exercise tolerance, although still observable, is reduced. Hypotension: Severe hypotension, particularly with upright posture, may occur even with small doses of nitroglycerin. The drug should therefore be used with caution in patients who may be volume-depleted or who, for whatever reason, are already hypotensive.

Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris. The benefits of NitroMist in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use NitroMist in these conditions, careful clinical or hemodynamic monitoring must be used because of the possibility of hypotension and tachycardia. Hypertrophic Cardiomyopathy: Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. Headache: Nitroglycerin produces dose-related headaches, which may be severe. Tolerance to headaches occurs. ADVERSE REACTIONS– Headache, which may be severe and persistent, may occur immediately after nitroglycerin use. Flushing, drug rash and exfoliative dermatitis have been reported in patients receiving nitrate therapy. Postural hypotension, as manifest by vertigo, weakness, palpitation, and other symptoms, may develop occasionally, particularly in erect, immobile patients. Marked sensitivity to the hypotensive effects of nitrates (manifested by nausea, vomiting, weakness, diaphoresis, pallor, and collapse) may occur at therapeutic doses. Syncope due to nitrate vasodilatation has been reported.

DRUG INTERACTIONS – PDE5 Inhibitors: Administration of NitroMist is contraindicated in patients who are using a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates. The time course and dose dependence of this interaction have not been studied, and use within a few days of one another cannot be recommended. Appropriate supportive care for the severe hypotension has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. The use of any form of nitroglycerin during the early days of acute myocardial infarction requires particular attention to hemodynamic monitoring and clinical status. Antihypertensives: Patients receiving antihypertensive drugs, beta-adrenergic blockers, and nitrates should be observed for possible additive hypotensive effects. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly. Labetolol blunts the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If labetolol is used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur. Aspirin: Coadministration of aspirin and nitroglycerin has been reported to result in increased nitroglycerin maximum concentrations by as much as 67% and AUC by 73% when administered as a single dose. The vasodilatory and hemodynamic effects of nitroglycerin may be enhanced by concomitant administration of aspirin. Tissuetype Plasminogen Activator (t-PA): Intravenous administration of nitroglycerin decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with nitroglycerin. Therefore, caution should be observed in patients receiving nitroglycerin during t-PA therapy. Heparin: Intravenous nitroglycerin reduces the anticoagulant effect of heparin. Activated partial thromboplastin times (APTT) should be monitored in patients receiving heparin and intravenous nitroglycerin. It is not known if this effect occurs following single nitroglycerin doses. Ergotamine: Oral administration of nitroglycerin markedly decreases the first-pass metabolism of dihydroergotamine and subsequently increases its oral bioavailability.

Ergotamine is known to precipitate angina pectoris. Therefore, patients receiving sublingual nitroglycerin should avoid ergotamine and related drugs or be monitored for symptoms of ergotism if this is not possible. USE IN SPECIFIC POPULATIONS– Pregnancy: Pregnancy category C: Animal reproduction and teratogenicity studies have not been conducted with NitroMist or nitroglycerin sublingual tablets. It is also not known whether NitroMist can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. A teratogenicity study was conducted in the third mating of F0 generation female rats administered dietary nitroglycerin for gestation day 6 to day 15 at dose levels used in the 3-generation reproduction study. In offspring of the high-dose nitroglycerin group, increased incidence of diaphragmatic hernias and decreased hyoid bone ossification were seen. The latter finding probably reflects delayed development rather than a potential teratogenic effect, thus indicating no clear evidence of teratogenicity of nitroglycerin. There are no adequate and well controlled studies in pregnant women. NitroMist should be given to a pregnant woman only if clearly needed. Nursing Mothers: It is not known whether nitroglycerin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when NitroMist is administered to a nursing woman. Pediatric Use: The safety and effectiveness of nitroglycerin in pediatric patients have not been established. Geriatric Use: Clinical studies of NitroMist did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other rep-

Not Actual Size

orted clinical experience has not identified differences in responses between elderly (greater than or equal to 65 years) and younger (less than 65 years) patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. OVERDOSAGE– Signs and symptoms of hemodynamic effects: The effects of nitroglycerin overdose are generally the results of nitroglycerin’s capacity to induce vasodilatation, venous pooling, reduced cardiac output, and hypotension. These hemodynamic changes may have protean manifestations, including increased intracranial pressure with any or all of persistent throbbing headache, confusion, and moderate fever; vertigo; palpitations; tachycardia; visual disturbances; nausea and vomiting (possibly with colic and even bloody diarrhea); syncope (especially in the upright posture); dyspnea, later followed by reduced ventilatory effort, diaphoresis, with the skin either flushed or cold and clammy; heart block and bradycardia; paralysis; coma; seizures; and death. No specific antagonist to the vasodilator effects of nitroglycerin is known, and no intervention has been subject to controlled study as a therapy of nitroglycerin overdose. Because the hypotension associated with nitroglycerin overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward increase in central fluid volume.

Passive elevation of the patient’s legs may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary. The use of epinephrine or other arterial vasoconstrictors in this setting is not recommended. In patients with renal disease or congestive heart failure, therapy resulting in central volume expansion is not without hazard. Treatment of nitroglycerin overdose in these patients may be subtle and difficult, and invasive monitoring may be required. Methemoglobinemia: Methemoglobinemia has been rarely reported with organic nitrates. The diagnosis should be suspected in patients who exhibit signs of impaired oxygen delivery despite adequate arterial PO2. Classically, methemoglobinemic blood is described as chocolate brown, without color change on exposure to air. If methemoglobinemia is present, intravenous administration of methylene blue, 1 mg/kg to 2 mg/kg of body weight, may be required.

NONCLINICAL TOXICOLOGY– Carcinogenesis, Mutagenesis, Impairment of Fertility: Animal carcinogenicity studies with sublingually administered or lingual spray nitroglycerin have not been performed. Rats receiving up to 434 mg/kg/day of dietary nitroglycerin for 2 years developed dose-related fibrotic and neoplastic changes in liver, including carcinomas, and interstitial cell tumors in testes. At the highest dose, the incidences of hepatocellular carcinomas was 52% compared to 0% in untreated controls. Incidences of testicular tumors were 52% vs 8% in controls. Lifetime dietary administration of up to 1058 mg/kg/day of nitroglycerin was not tumorigenic in mice. Nitroglycerin was found to have reverse mutation activity in the Salmonella typhimurium strain TA1535 (Ames assay). A similar mutation in S. typhimurium strain was also reported for other NO donors. Nevertheless, there was no evidence of mutagenicity in an in vivo dominant lethal assay with male rats treated with oral doses of up to about 363 mg/kg/day or in ex vitro cytogenic tests in rat and dog tissues. In vitro cytogenetic assay using Chinese hamster ovary cells showed no chromosomal aberrations. In a 3-generation reproduction study, rats received dietary nitroglycerin at doses up to about 408 mg/kg/day (males) to 452 mg/kg/day (females) for 5 months (females) or 6 months (males) prior to mating of the F0 generation with treatment continuing through successive F1 and F2 generations. The highest dose was associated with decreased feed intake and body weight gain in both sexes at all matings. No specific effect on the fertility of the F0 generation was seen. Infertility noted in subsequent generations, however, was attributed to increased interstitial cell tissue and aspermatogenesis in the high-dose males. PATIENT COUNSELING INFORMATION– Interaction with PDE5 Inhibitors - NitroMist should not be used in patients who are using medications for erectile dysfunction such as sildenafil, vardenafil, and tadalafil.

These products have been shown to increase the hypotensive effects of nitrate drugs such as NitroMist. Administration - Patients should be instructed that prior to initial use of NitroMist Lingual aerosol, the pump must be primed by pressing the actuator button 10 times to ensure proper dose priming. If the product is not used for more than 6 weeks, the bottle can be adequately re-primed with 2 sprays. NitroMist is meant to be sprayed on or under the tongue at the beginning of angina or to prevent an angina attack. Treatment with nitroglycerin products such as NitroMist may be associated with lightheadedness on standing, especially just after rising from a laying or seated position. This effect may be more frequent in patients who have consumed alcohol, since alcohol use contributes to hypotension. If possible, patients should be seated when taking NitroMist. This reduces the likelihood of falling due to lightheadedness or dizziness. Headache - Headaches can sometimes accompany treatment with nitroglycerin. In patients who get these headaches, the headaches may indicate activity of the drug. Tolerance to headaches develops. Flushing - Flushing, drug rash and exfoliative dermatitis have been reported in patients receiving nitrate therapy. Container information - The NitroMist bottle should not be forcefully opened. Because NitroMist contains a highly flammable propellant (butane), do not have the container burned after use and do not spray directly towards flames. While the container is in the upright position, if the liquid reaches the top to middle of the hole on the side of the container, a new supply should be obtained. When the liquid reaches the bottom of the hole, the remaining doses will have less than label content.

Manufactured for Akrimax Pharmaceuticals, LLC E Cranford, NJ 07016

by Dynamit Nobel GmbH, Leverkusen, Germany E Marketed and Distributed by: Akrimax Pharmaceuticals, LLC, Cranford, NJ 07016 USA NitroMist is a registered trademark of NovaDel Pharma Inc., used by permission.

141B002 10/2012

*Priming NitroMist: After receiving a new prescription or refill, patients should remove the plastic cap, place forefinger on actuator button, and press 10 times. NitroMist is now primed for 6 weeks and ready to use. If not used for more than 6 weeks, the NitroMist bottle can be adequately reprimed with 2 sprays. † Store at room temperature (25°C, 77°F); excursions permitted to 15-30°C (59-85°F).

NitroMist is a registered trademark of NovaDel Pharmaceuticals, LLC., used by permission.

©2012 Akrimax Pharmaceuticals, LLC., Cranford, NJ 07016 October 2012 NTR-145T